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Gastrointestinal > Viral Hepatitis: B and D > Flashcards

Viral Hepatitis: B and D Flashcards

1
Q

Define Viral Hepatitis?

A

Hepatitis caused by infection with HBV, which may follow an acute or chronic course

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2
Q

What is Chronic Viral Hepatitis?

A

Defined as viraemia and hepatic inflammation continuing for > 6 months

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3
Q

What is HDV?

A

It is a defective virus, that may only co-infect with HBV or superinfect people who are already carriers of HBV

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4
Q

What is HBV?

A

It is an enveloped, partially double-stranded DNA virus

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5
Q

What is the transmission of HBV?

A

Sexual contact
Blood
Vertical transmission (from mother to baby)

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6
Q

What viral proteins are produced in HBV?

A 
Core antigen (HBcAg)
Surface antigen (HBsAg)
e antigen (HBeAg)
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7
Q

What is the significance of the e antigen (HBeAg)?

A

It is a marker of high infectivity

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8
Q

What is HDV?

A

It is a single-stranded RNA virus coated with HBsAg

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9
Q

What is the aetiology of HDV?

A

Antibody and cell-mediated immune response to viral replication leads to liver inflammation and hepatocyte necrosis
Histology can show mild to severe inflammation and changes to cirrhosis

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10
Q

What are the risk factors of HDV?

A

IV drug use
Unscreened blood and blood products
Infants of HBeAg-positive mothers
Sexual contact with HBV carriers
Younger individuals (particularly babies) are more likely to become chronic carriers
Genetic factors are associated with varying rates of viral clearance

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11
Q

What is the epidemiology of HBV and HDV?

A

Common
1-2 million deaths annually
Common in SE Asia, Africa and Mediterrean countries
HDV is also found worldwide

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12
Q

What is the incubation period for HBV and HDV?

A

3-6 months

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13
Q

What are the presenting symptoms in the 1-2 week prodrome for HBV and HDV?

A 
Malaise 
Headache 
Anorexia 
Nausea and vomiting 
Diarrhoea 
RUQ pain 
Serum-sickness type illness
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14
Q

What are some of the symptoms associated with Serum-sickness type illness?

A 
Fever
Arthralgia 
Polyarthritis 
Urticaria 
Maculopapular rash
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15
Q

What is another symptom of HBV and HDV?

A

Jaundice develops with dark urine

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16
Q

How long does it take to recover from HBV and HDV?

A

4-8 weeks

17
Q

What percentage of patients with HBV and HDV develop fulminant liver failure?

A

1%

18
Q

What are the Acute signs of HBV and HDV?

A

Jaundice
Pyrexia
Tender hepatomegaly
Splenomegaly
Cervical lymphadneopathy (in 10-20% of patients)
Occsaionally: urticaria and maculopapular rash

19
Q

What are the chronic signs of HBV and HDV?

A

May be no findings

May have signs of chronic liver disease or decompensation

20
Q

What investigations do you do for HBV and HDV?

A

Viral Serology
LFTs
Clotting
Liver Biopsy

21
Q

What Viral Serology tests do we see for Acute HBV?

A

HBsAg positive

IgM anti-HBcAg

22
Q

What Viral Serology tests do we see for Chronic HBV?

A

HBsAg positive
IgG anti-HBcAg
HBeAg positive or negative

23
Q

What viral serology tests do we do for HBV cleared or vaccinated against HBV patients?

A

Anti-HBsAg antibody positive

IgG anti-HBcAg

24
Q

What viral serology tests do we see for an HDV infection?

A

Detected by IgM or IgG against HDV

PCR is used for detection of HDV

25
Q

What do we look for on the LFTs for HBV and HDV?

A 
HIGH:
AST
ALT
ALP
Bilirubin
26
Q

What clotting test do we do for HBV and HDV?

A

High PT (in severe disease)

27
Q

What prevention do we do for HBV and HDV?

A

Blood screening
Safe sex
Instrument sterilisation

28
Q

What is the Passive Immunisation for HBV and HDV?

A

Hepatitis B Immunoglobulin following acute exposure and to neonates born to HBeAg-positive mothers (in addition to active immunisation)

29
Q

What is the Active Immunisation for HBV and HDV?

A

Recombinant HBsAg vaccine for individuals at risk and neonates born to HB

30
Q

What is the mananagement plan for Acute HBV Hepatitis?

A 
Symptomatic treament (antipyretics, antiemetics and cholestyramine) and bed rest
Notifiable disease
31
Q

What is the management plan for Chronic HBV?

A 
Interferon alpha (standard or pegylated)
Nucleoside/nucleotide analogues (adefovir, entercavir, telbivudine, tenofovir)
32
Q

What are the side effects of Interferon alpha in the treatment of Chronic HBV?

A

Flu-like symptoms such as fever, chills, myalgia, headaches, bone marrow suppression and depression

33
Q

What are the possible complications of HBV and HDV?

A

1% get fulminant hepatic failure
Chronic HBV infection (10% of adults, much higher in neonates)
Cirrhosis
HCC
Extrahepatic immune complex disorders (e.g. glomerulonephritis, polyarteritis nodosa)
Superinfection with HDV may lead to acute liver failure or more rapidly progressive disease

34
Q

What is the prognosis of patients with HBV and HDV?

A

Adults: 10% of infections become chronic

Of the chronic infections, 20-30% will develop cirrhosis

Gastrointestinal (61 decks)

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